Training in Paediatric Neurology
Louise Hartley (louhartley@aol.com) is the trainees representative. The next trainees meeting will be held on 21st October 2000 at the Lacemarket Hotel, Nottingham. Louise also maintains a list of email addresses of trainees.
Training guidelines (updated June 1999)
Background
Since the previous paediatric neurology training guidelines were produced in 1982, there
have been many changes in both paediatric neurology and professional training in general.
There is a general aim of harmonising the training throughout Europe or at the very least
understanding the training in each country so that it is easy for people to move between
European countries. The Calman report has also lead to a shortening of professional
training in the UK. The programme described is regarded as a minimum and many doctors may
benefit from at least one further year in training.
Obligatory training
1. Two years of general paediatrics including experience of neonates.
2. Those accepted for higher training would be expected to have obtained MRCP or an
equivalent qualification.
3. Two years clinical paediatric neurology involving direct patient care, fully
supervised, in a department with access to the full range of neuroscience investigations.
This acute neurological training should include neurosurgical and intensive care work.
4. One year paediatric neurodisability which should include some secondary community
as well as tertiary level work.
The paediatric neurology training could start at SHO level but would be mainly at the
Specialist Registrar grade. The general acute and disability paediatric neurology
experience can be integrated.
5. Six months adult neurology. The previous recommendation was one year but many people
have done only 6 months. In general they have found this valuable experience in the
clinical examination of the nervous system, experience of a range of pathologies that are
less common in childhood and in understanding the discipline with which they are in
continuity from the point of view of patient care. Ideally this should be built into a
neurosciences rotation. Many have found that SHO level is the most useful for gaining this
experience.
6. Child Psychiatry. Because of the high rate of psychiatric illness in children with
brain disease, child psychiatry either as a separate appointment or more appropriately as
a module within the paediatric neurology training is essential with the minimum being one
day per week for a year. This should include some academic teaching in this subject.
7. Paediatric neurology is a broad subject and it is recognised that trainees will often
take a special interest in one area, eg neuromuscular disease, metabolic disease,
neuropsychiatry, intensive care etc but narrow specialisation is not encouraged at the
training stage.
8. Those in training should have a named tutor who would transfer supervisory
responsibility when necessary, eg as with two site training schemes.
9. Major neurosciences units and collaborative services on several sites should aim to
take people for training in paediatric neurology by providing a three and a half to four
year co-ordinated package.
10. An organised clinical skills training and a teaching programme with completely
protected time should be available. The latter should occupy at least half a day a week
for neuroanatomy, genetics,bio-chemistry, neurophysiology, neuroradiology and
neuropsychology over a period of probably 6 terms though some circumstances may require
equivalent training time in blocks. Research methodology should be included within that
training. One aim of this training is to develop the trainees' teaching skills.
We recommend however that a taught MSc in paediatric neurosciences should be rapidly
developed to provide this combination of clinical and academic training. The provision of
a senior staff member, paid study leave and funding to cover the course fees is essential.
11. Research during training: We would retain the view that a period of research is
desirable but not obligatory. We should insist that there should be a minimum of 4-6
months total equivalent which provides the opportunity to either work on a pilot research
project or explore one particular area of paediatric neuroscience. This again requires a
supervisor who may not be the clinical tutor. With that in mind, funded clinical research
fellow or lecturer appointments in paediatric neurology are required to allow more
extended time in research and the opportunity to obtain longer time funding.
Since PhD research projects require 3 years and training in research, this could greatly
lengthen the training time for academic paediatric neurologists as distinct from those who
are taking a mainly clinical training. Therefore a programme for training in academic
paediatric neurology could be constructed in which the general paediatric 2 years
remained, 2 years of clinical neurology including disability are required and 3 years of
research work. PhD students could take modules from an MSc course when it becomes
available within the 3-year period. We recognise that an academic paediatric neurologist
training may not cover all aspects of clinical neurology and this makes the selection of
PhD students on academic potential very important. The training outlined is the minimum
and some additional training may be required to fulfil a comprehensive regional
appointment but this should be dealt with on an individual basis.
12. In order to provide the required level of experience, the requirements for the
clinical service of the training department are that there should be at least two
whole-time equivalent paediatric neurologists. Departments staffed by one paediatric
neurologist should link with another centre fulfilling this minimum criterion. There
should be a close relationship with a general neurosciences centre. There should be an
agreed training programme.
The on call commitment should allow experience of a wide range of acute neurology both
primary neurological disease and neurological aspects of major non-neurological
disease.
13. Entry from adult neurology
Following 2 years or more adult neurology training, doctors may enter paediatric
neurology. They will be required to have a minimum of one year general paediatric training
at SHO level, and their paediatric competence approved and 2 years paediatric neurology
including the taught training programme.
14. Continuing education
Consultants in post should attend regular clinical practice update sessions as organised
by the BPNA.
15. District-based paediatric neurology
There have been proposals for district-based consultant posts in paediatric neurology but
at the time of preparing this report the B.P.N.A. feels that there is insufficient
information about the effectiveness of this innovation and that its first priority is to
achieve full tertiary level staffing. If, however, such an appointment is made it should
be for a fully trained paediatric neurologist and have at least 2 sessions in the tertiary
unit.
Training pathway
Full registration is likely to be by 24 years of age. A further 2 years of paediatrics
(gaining MRCP) would be achieved by 26/27 years. Thereafter either of the following will
be expected:-
Clinical track 31/2years clinical + 1 year MSc/flexible
Academic track 2 years clinical + 3 years research
The anticipated age for completion of minimum training by either clinical or academic
track will be 31-32 years.
Training in Paediatric Neurology should include those subjects listed in the appendix. A
training record will be kept and the subject list should be reviewed by both the trainee
and the supervisor at regular intervals during training to ensure adequate coverage.
BPNA TRAINING COMMITTEE SEPT. ’99
The job description of the Regional Training Advisers, the syllabus and methods of
assessment for Trainees, and the Training Requirement have all been the subject of review
by the National Training Committee this year. It must be emphasised that the basic
Training requirement remains unaltered and as it appears in the College Paediatric
Training Handbook: at least two years must be spent in paediatric neurology and one in
neurodisability ( these three years may be integrated ), six months in adult neurology,
and the equivalent of a day each week for a year in child psychiatry. Now, as most senior
registrars are being appointed as consultants most trainees will enter their paediatric
neurology training as a specialist registrar at the end of year one or two. It is
essential that twelve months of this time is spent in a relevant paediatric subspecialty
such as neonatal intensive care, or community paediatrics with adequate, supervised
neurodisability or educational medicine training so that the full complement of the 41/2
years training in neurology can be met. Not all general paediatric training posts will be
considered: the content is critical. Trainees in a research oriented programme must
fulfill the same requirements except that the neurology/disability component may be
shortened to two years, giving five years overall.
The idea of trainees keeping a logbook is not favoured. Trainees will be encouraged to
keep a portfolio of their clinical, teaching and research activities to be presented at
the annual appraisal/assessment meeting. A critical appraisal of the value of the weekly
structured teaching in paediatric neurology which all training centres must provide should
be kept. This will allow local development and improvement of teaching programmes and
facilities.
The Regional Training adviser should be contacted as soon as possible after appointment to
ensure that placement in posts during the training period will lead to the development of
skills in all the relevant areas. The National Training Adviser should be contacted
towards the end of the penultimate year to ensure the CCST date is agreed by all parties.
Paediatric neurology will usually be practised as a single specialty not including general
paediatrics, from a base in a regional centre. Trainees should be warned that there is no
subspecialty recognition for a general paediatrician with an interest in paediatric
neurology; for a trainee to register their specialty interest they must have fulfilled the
full neurology training requirement.
It is hoped that a distance learning will soon allow Trainees to follow a national formal
Neuroscience MSc programme - more of this soon.